Provider Demographics
NPI:1588204309
Name:LADNER AND JAIN ORTHODONTICS, LLP
Entity Type:Organization
Organization Name:LADNER AND JAIN ORTHODONTICS, LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TREATMENT COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:ANGIE
Authorized Official - Middle Name:
Authorized Official - Last Name:GUNTHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:309-343-8727
Mailing Address - Street 1:1171 N HENDERSON ST
Mailing Address - Street 2:
Mailing Address - City:GALESBURG
Mailing Address - State:IL
Mailing Address - Zip Code:61401-2523
Mailing Address - Country:US
Mailing Address - Phone:309-343-8727
Mailing Address - Fax:309-342-0491
Practice Address - Street 1:1171 N HENDERSON ST
Practice Address - Street 2:
Practice Address - City:GALESBURG
Practice Address - State:IL
Practice Address - Zip Code:61401-2523
Practice Address - Country:US
Practice Address - Phone:309-343-8727
Practice Address - Fax:309-342-0491
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-09
Last Update Date:2020-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty